GU

Question 1

Medullary nephrocalcinosis

Answer 1

• Adult:
  ○ Medullary sponge kidney
  ○ RTA
  ○ hyperPTH
• Infant
  ○ Lasix tx
  ○ Idiopathic hypercalcemia - Williams syndrome (immediate newborn)
  Hypervitaminosis D
  Metastatic carcinoma to bone
  Milk alkali syndrome
  Multiple myeloma
  Renal tubular acidosis
  Sarcoidosis

Question 2

Cortical nephrocalcinosis

Answer 2

○ Chronic glomerulonephritis
○ Acute cortical necrosis / ischemia
§ Pregnancy, sepsis, trauma, nephrostoxins (ethylene glycol)
§
§ Appearance of acute cortical necrosis above is before calcification of cortex occurs (see band of hypodensity within cortex representing ischemia)
○ Chronic transplant rejection
○ AIDS nephropathy, especially with PCP and MAI infection of kidney (ca++ often more patchy)
○ Alport syndrome (nephritis, nerve deafness, hematuria, ocular abnormalities)
○ Congenital Oxalosis
○ Hypercalcemia
“COAG”: Cortical Necrosis (Pregnancy, Shock, Infection, Toxins), Oxalosis, Alport syndrome/AIDS nephropathy, Glomerulonephritis (chronic membranous glomerulonephritis)

Question 3

• Causes of medullary nephrocalcinosis in peds

Answer 3

○ Lasix
○ Hypophosphatemic rickets
○ hyperPTH
○ Distal RTA (type 1)
○ Medullary sponge kidney
○ Chronic glomerulonephritis

Question 4

pear shaped UB

Answer 4

○ Pelvic fluid (hematoma, lymphocele, urinoma, abscess)
○ Pelvic lipomatosis
○ Vascular (B iliac artery aneurysms, IVC, occlusion with collaterals)
○ LAD

Psoas muscle hypertrophy

Question 5

renal papillary necrosis

Answer 5

§ DDX: (POSTCARD) Pyelonephritis, Obstruction, Sickle cell disease, Tuberculosis, Cirrhosis, coagulopathy, christmas disease, Analgesic abuse, Renal vein thrombosis, and Diabetes mellitus

• unilateral: obstruction, infection (TB, etc), RVT
  bilateral: DM, analgesics

Question 6

Birt Hogg Dube syndrome

Answer 6

cutaneous hair follicle tumors (fibrofolliculomas), pulmonary cysts with spontaneous PTX, renal tumors (oncocytoma, RCC)

Question 7

bilateral adrenal ca++

Answer 7

○ Post hemorrhagic
○ Post infectious (TB, histoplasmosis)
○ Treated mets
○ Idiopathic
○ Wolman diseae (rare)

Question 8

Low signal T2 renal cortex

Answer 8

○ Paroxysmal nocturnal hemoglobinuria
○ Sickle cell disease
○ Hemorrhagic fever with renal syndrome
○ Acute renal vein thrombosis
○ Renal cortical necrosis
○ Renal infarct

Question 9

bilateral testicular mases

Answer 9

○ Leukemia/lymphoma
○ Metastatic disease
○ Adrenal rests (in congenital adrenal hyperplasia)
○ Leydig cell hyperplasia (LH or HCG elevated)

Question 10

DDx biliary stricture

Answer 10

○ Inflammatory: pancreatitis, stone passage, ischemia, recurrent infection/cholangitis
○ Neoplasm: cholangioCA, pancreatic ca
○ Trauma: surgery or otherwise
○ Extrinsic compression: pancreatitis, mets (lung, breast, GI) in porta hepatis, peripancreatic or periduodenal nodes from lymphoma or reactive, Mirizzi, GB CA, liver tumor

Question 11

Bilateral renal enlargement

Answer 11

APCKD

• tumor/malignancy (leukemia, lymphoma, MM)
• Inflammation (acute GN, interstitial nephritis, cvd, atn)
• metabolic (amyloid, DM, storage diseases, acromegaly)
• vascular - bilateral renal vein thrombosis

AIDS nephropathy

Question 12

Unilateral renal enlargement

Answer 12

• ureteral obstruction

duplication anomalies and hypertrophy

pyelonephritis

XGP

contusion

infiltrating neoplasm

acute renal vein occlusion

acute arterial occlusion and arteritis

Question 13

small scarred kidney

Answer 13

unilateral: reflux, previous renal surgery,
bilateral: renal infarcts, analgesic nephropathy, bilateral reflux nephropathy

Question 14

small smooth kidney

Answer 14

Normal calyces

• ras
• chronic rvt
• renal hypoplasia
• subcapsular hematoma
• radiation therapy

abnormal calyces

• post obstructive atrophy